The prognostic impact of metastatic pattern of lymph nodes in patients with oral and oropharyngeal squamous cell carcinomas
The prognostic impact of metastatic pattern of lymph nodes in patients with oral and oropharyngeal squamous cell carcinomas
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DOI：
10.1007/s00405-003-0678-8
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发表时间：
2004-05-01
影响因子：
2.6
通讯作者：
Metternich, FU
中科院分区：
文献类型：
--
作者：
Wenzel, S;Sagowski, C;Metternich, FU
在口腔和口咽部鳞状细胞癌患者中，淋巴结转移的存在或不存在仍然是最重要的预测因素。囊外扩散的鉴别意义和原发肿瘤的特征（如浸润的大小和深度）对转移模式、治疗失败和生存的影响进行了评价。对115例连续治疗的患者进行了5年的术后随访，回顾性研究了远处转移、局部和区域复发的发生率以及5年生存率。根据组织学类型评估原发肿瘤和淋巴结转移的最大浸润深度，并根据组织学诊断对患者进行分组。与其他T大小相比，T4类别对远处转移、复发肿瘤和生存率的发生率具有明显的区分性影响。淋巴结转移的N0分类、结内生长和结外生长导致5年生存率分别为67%、59%和31%。根据分型，5年后无淋巴结复发者分别为84、87和59%，无远处转移者分别为79、82和46%。原发肿瘤的大小和浸润深度与包膜外扩散的发生无明显关系。口腔鳞状细胞癌的淋巴结状态和口咽转移，特别是包膜破裂，对预后影响最大。囊外扩散的组织学特征可以区分口腔和口咽鳞状细胞癌的重复性高危患者。
In patients with squamous cell carcinomas of the oral cavity and the oropharynx the presence or absence of nodal metastases still is the most important predictive factor. The discriminative significance of extracapsular spread and the influence of features of the primary tumor-such as size and depth of invasion-on metastatic pattern, treatment failure and survival were evaluated. Five-year postoperative follow-ups of 115 consecutively treated patients were studied retrospectively concerning the incidence of distant metastases, local and regional recurrences and the 5-year survival rate. Maximum depth of invasion of the primary tumor and lymph node metastases were evaluated on the basis of histological patterns, and patients were grouped according to their histological diagnosis. The T4 category has a plain discriminative influence on the incidence of distant metastases, recurrent tumors and survival rate in contrast to the other T sizes. The classification N0, intranodal growth and extranodal growth of lymph node metastases resulted in a 5-year survival rate of 67, 59 and 31%. According to the classification, 84, 87 and 59% were without nodal recurrence after 5 years, and 79, 82 and 46% without distant metastases. Size and depth of invasion of the primary tumor are not connected significantly with the occurrence of extracapsular spread. The status of the lymph nodes in squamous cell carcinomas of the oral cavity and the oropharynx metastases and in particular the capsular rupture has the most significant prognostic influence. The histological feature of extracapsular spread could distinguish reproducibly high risk patients with squamous cell carcinomas of the oral cavity and the oropharynx.